MEDICARE: KANDASWAMY JAYARAJ MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	L6963	TX

General Provider Information

NPI Number	:	1043218514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANDASWAMY JAYARAJ MD PA

Provider Business Mailing Address
First Line	:	PO BOX 12499
Second Line	:	3030 N ST #310
City	:	BEAUMONT
State	:	TX
Zip	:	77726-2499
Country	:	US
Telephone Number	:	409-892-2111
Fax Number	:	409-892-2173

Provider Business Practice Location Address
First Line	:	3030 NORTH ST
Second Line	:	#310
City	:	BEAUMONT
State	:	TX
Zip	:	77702-1433
Country	:	US
Telephone Number	:	409-892-2111
Fax Number	:	409-892-2173

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KANDASWAMY JAYARAJ
Credential	:	MD
Telephone Number	:	409-892-2111

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	11/05/2007

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